Assignment Instruction

Students will complete an Assignment worth $20\%$ of their final mark.

Your Assignment will be assessed for its quality, not the quantity of your response.

Students will work together and resolve on their own any difficulties in group work.

Students in the group will share the same mark for the work.

If a group submitted the work that another group has prepared and$/$or paraphrased that work, a reduced grade of $15\%$ will be imposed.

Each student in the assigned group will choose one role from the incident scenario.

If some facts are not provided, you will have to make reasonable assumptions.

Tools to help you complete the Assignment successfully

Read the workplace incident scenario provided in your Assignment $-$ Conducting Incident Investigation $($see below$).$

To conduct an investigation and record the findings download Employer Incident Investigation Report $($EIIR Form $52$E$40)($use DOC version for the convenience$).$

Watch Assignment$\_$Video Instruction that I have recorded to guide you on how to complete this activity $($provided in learn.ncit$).$

$3\mathrm{.}1.$ Watch Incident Investigation Reporting $($video by WorkSafeBC$)$ to understand the general concept of the workplace incident investigation.

$3\mathrm{.}2.$ Refer to the Guide to Completing an Employer Incident Investigation Report $($EIIR$)$ to go through the process of completing an EIIR.

$3\mathrm{.}3.$ Refer to the Sample of the completed Incident Investigation Report $($EIIR$)$ to understand how completed EIIR form should look like.

Divide the roles among the members of your group. Each member will be responsible for providing corrective actions.

Assignment evaluation

Worth $5\%.$ The group filled all the required sections correctly.

Worth $5\%.$ The group carefully analyzed the scenario and clearly described the sequence of events that preceded the incident.

Worth $5\%.$ The group identified the root causes of the incident.

Worth $5\%.$ The group articulated a well$-$developed and appropriate control measure.

Incident Scenario

Please read the scenario below and complete sections $1$ to $19$ of the Employer Incident Investigation Report $($EIIR$)$

Employer Incident Investigation Report $($EIIR$)$

Please refer to the companion quick guide for assistance completing the investigation and this form. Please attach a separate sheet if necessary

Employer's information

$\backslash$table$[[,$Operating location number,WorkSafeBC account number$],[$Employer$\text{'}$s head office address,,$],[$City$,$Province,Postal code$],[$Employer$\text{'}$s representative's name,,Phone number $($Include area code$)]]$

Injured persons

$\backslash$table$[[$Last name,First name,Job title,$],[$a$),,,],[$b$),,,],[$c$),,,],[$d$),,,]]$

Place, date, and time of incident

Type of occurrence $($select all that apply$)$

Death of a worker

Dangerous incident involving explosives other than blasting incident

Serious injury to a worker

Diving incident, as defined by regulation

Major structural failure or collapse

Incident of fire or explosion with potential for serious injury

Major release of hazardous substance

Minor injury or no injury but had potential for causing serious injury

Blasting accident causing personal injury

Injury requiring medical treatment beyond first aid

An incident investigation report is NOT required under the Workers Compensation Act if none of the above applies or if this incident is a vehicle acdident occurring on a public street or highway.

$5.$ Report type $($select all that apply$)$ If this is a revised version of a previous report, please check here $.$

$\backslash$table$[[\backslash$table$[[$Preliminary Investigation$],[$Report$],[$If requested only, provide a copy$],[$to WorkSafeBC.$]],\backslash$table$[[$ Interim Corrective$],[$Action Report$]],\backslash$table$[[$Full Investigation Report$],[$Must be provided$],[$to WorkSafeBC within $30$ days$*],[$Fax $1\mathrm{.}866\mathrm{.}240\mathrm{.}1434]],\backslash$table$[[$ Full Corrective$],[$Action Report$]]],[$Report date $-$mm$-$dd$),$Report date $(yyy-mm-dd),$Report date $(yny-mm-dd),$Report date $($yyyy$-$mm$-$dd$)],[$Officer$\text{'}$s name,,Date sent $(yy-mm-dd),]]$

$52E40$

$($R$23/07)$ Page $1$ of $5$

s$.$ View permissions

Employer Incident Investigation Report $($EIIR$)$

$6.$ Witnesses

$\backslash$table$[[$Last name,First name,Job title$],[$a$),,],[$b$),,],[$c$),,]]$

Other persons whose presence might be necessary for proper investigation

$\backslash$table$[[$Last name,First name,Job title$],[$a$),,],[$b$),,]]$

Sequence of events that preceded the incident

Required in Preliminary Report. Update in Full Report if necessary. Describe events earlier that day or even in previous years that led up to the incident. Examples may indude events such as training given or changes in equipment, procedures, or company management.

$9.$ Unsafe conditions, acts, or procedures that significantly contributed to the incident

Required in all reports. Describe anything, or the absence